Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1997 Aug;52(8):718–722. doi: 10.1136/thx.52.8.718

Respiratory mechanics after heart-lung and bilateral lung transplantation

R A Chacon, P A Corris, J H Dark, G J Gibson
PMCID: PMC1758629  PMID: 9337832

Abstract

BACKGROUND: The factors determining respiratory mechanics following heart-lung transplantation (HLT) and bilateral lung transplantation (BLT) are incompletely understood. METHODS: The dynamic and static lung volumes of 15 patients after HLT (n = 6) and BLT (n = 9) with no evidence of obliterative bronchiolitis were analysed to assess the factors which determine lung volumes following transplantation. Post- transplantation total lung capacity (TLCpost) was compared with the size of the recipient's lungs (TLCpre), the predicted capacity of the thorax of the recipient (TLCpred), and the predicted size of the donor's lungs (TLCdon). In addition, the post-transplantation respiratory mechanics were investigated by measuring the static pressure-volume (PV) curve of the lungs and the maximum respiratory pressures in a subgroup of nine patients (four HLT, five BLT). RESULTS: TLCpost was closely related to TLCpred in both groups and showed no correlation with TLCpre. The mean (95% CI) TLCpost was 102.5 (90.2 to 115)% predicted for the recipient in the HLT group and 109 (97.6 to 120)% predicted for the recipient in the BLT group. Despite the near normal TLC, residual volume (RV) and functional residual capacity (FRC) remained increased after transplantation in both groups. These abnormalities were not attributable to either airflow obstruction or expiratory muscle weakness. On average, lung compliance expressed in terms of the shape constant of the static pressure-volume curve of the lungs was mildly reduced in both groups compared with values predicted for the recipient. CONCLUSIONS: These results suggest that at high lung volumes the chest wall adapts to the size of transplanted lungs, while at lower volumes the increase in FRC and RV might be due to a persistent change in the static pressure-volume curve of the chest wall. 




Full Text

The Full Text of this article is available as a PDF (131.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Burke C. M., Theodore J., Baldwin J. C., Tazelaar H. D., Morris A. J., McGregor C., Shumway N. E., Robin E. D., Jamieson S. W. Twenty-eight cases of human heart-lung transplantation. Lancet. 1986 Mar 8;1(8480):517–519. doi: 10.1016/s0140-6736(86)90881-0. [DOI] [PubMed] [Google Scholar]
  2. Colebatch H. J., Greaves I. A., Ng C. K. Exponential analysis of elastic recoil and aging in healthy males and females. J Appl Physiol Respir Environ Exerc Physiol. 1979 Oct;47(4):683–691. doi: 10.1152/jappl.1979.47.4.683. [DOI] [PubMed] [Google Scholar]
  3. Cooper J. D., Patterson G. A., Grossman R., Maurer J. Double-lung transplant for advanced chronic obstructive lung disease. Am Rev Respir Dis. 1989 Feb;139(2):303–307. doi: 10.1164/ajrccm/139.2.303. [DOI] [PubMed] [Google Scholar]
  4. Gibson G. J., Pride N. B., Davis J., Schroter R. C. Exponential description of the static pressure-volume curve of normal and diseased lungs. Am Rev Respir Dis. 1979 Oct;120(4):799–811. doi: 10.1164/arrd.1979.120.4.799. [DOI] [PubMed] [Google Scholar]
  5. Gibson G. J., Pride N. B. Lung distensibility. The static pressure-volume curve of the lungs and its use in clinical assessment. Br J Dis Chest. 1976 Jul;70(3):143–184. doi: 10.1016/0007-0971(76)90027-9. [DOI] [PubMed] [Google Scholar]
  6. Glanville A. R., Theodore J., Harvey J., Robin E. D. Elastic behavior of the transplanted lung. Exponential analysis of static pressure-volume relationships. Am Rev Respir Dis. 1988 Feb;137(2):308–312. doi: 10.1164/ajrccm/137.2.308. [DOI] [PubMed] [Google Scholar]
  7. Griffith B. P., Hardesty R. L., Trento A., Paradis I. L., Duquesnoy R. J., Zeevi A., Dauber J. H., Dummer J. S., Thompson M. E., Gryzan S. Heart-lung transplantation: lessons learned and future hopes. Ann Thorac Surg. 1987 Jan;43(1):6–16. doi: 10.1016/s0003-4975(10)60157-9. [DOI] [PubMed] [Google Scholar]
  8. Guignon I., Cassart M., Gevenois P. A., Knoop C., Antoine M., Yernault J. C., Estenne M. Persistent hyperinflation after heart-lung transplantation for cystic fibrosis. Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):534–540. doi: 10.1164/ajrccm.151.2.7842217. [DOI] [PubMed] [Google Scholar]
  9. Kaiser L. R., Pasque M. K., Trulock E. P., Low D. E., Dresler C. M., Cooper J. D. Bilateral sequential lung transplantation: the procedure of choice for double-lung replacement. Ann Thorac Surg. 1991 Sep;52(3):438–446. doi: 10.1016/0003-4975(91)90903-4. [DOI] [PubMed] [Google Scholar]
  10. Knudson R. J., Clark D. F., Kennedy T. C., Knudson D. E. Effect of aging alone on mechanical properties of the normal adult human lung. J Appl Physiol Respir Environ Exerc Physiol. 1977 Dec;43(6):1054–1062. doi: 10.1152/jappl.1977.43.6.1054. [DOI] [PubMed] [Google Scholar]
  11. Lloyd K. S., Barnard P., Holland V. A., Noon G. P., Lawrence E. C. Pulmonary function after heart-lung transplantation using larger donor organs. Am Rev Respir Dis. 1990 Nov;142(5):1026–1029. doi: 10.1164/ajrccm/142.5.1026. [DOI] [PubMed] [Google Scholar]
  12. Otulana B. A., Mist B. A., Scott J. P., Wallwork J., Higenbottam T. The effect of recipient lung size on lung physiology after heart-lung transplantation. Transplantation. 1989 Oct;48(4):625–629. [PubMed] [Google Scholar]
  13. Reitz B. A., Wallwork J. L., Hunt S. A., Pennock J. L., Billingham M. E., Oyer P. E., Stinson E. B., Shumway N. E. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med. 1982 Mar 11;306(10):557–564. doi: 10.1056/NEJM198203113061001. [DOI] [PubMed] [Google Scholar]
  14. Tamm M., Higenbottam T. W., Dennis C. M., Sharples L. D., Wallwork J. Donor and recipient predicted lung volume and lung size after heart-lung transplantation. Am J Respir Crit Care Med. 1994 Aug;150(2):403–407. doi: 10.1164/ajrccm.150.2.8049822. [DOI] [PubMed] [Google Scholar]
  15. Theodore J., Jamieson S. W., Burke C. M., Reitz B. A., Stinson E. B., Van Kessel A., Dawkins K. D., Herran J. J., Oyer P. E., Hunt S. A. Physiologic aspects of human heart-lung transplantation. Pulmonary function status of the post-transplanted lung. Chest. 1984 Sep;86(3):349–357. doi: 10.1378/chest.86.3.349. [DOI] [PubMed] [Google Scholar]
  16. Wilson S. H., Cooke N. T., Edwards R. H., Spiro S. G. Predicted normal values for maximal respiratory pressures in caucasian adults and children. Thorax. 1984 Jul;39(7):535–538. doi: 10.1136/thx.39.7.535. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES